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Joined: 21 Jan 2019
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Quote Hopefull75 Replybullet Topic: Concerned over 80gm Pantoprazole ++
    Posted: 21 Jan 2019 at 11:03pm
Not sure if I am doiing this correctly. But here goes being brief for first post: I am 75 and I have been on 80gm Pantoprazole plus 300 Ranatidine per day for over a year for GERD/acid reflux. I have read Chris Ribinson's excellent book and whilst he states that PPIs are safe, he does not mention for how long? Has anyone been taking such high doses for over a year (plus Ranitidine if appropriate) and if so have they suffered any side effects?
Any advice on how to proceed and any reassurance welcome.
Kind regards. Hopefull75
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Quote chrisrob Replybullet Posted: 22 Jan 2019 at 10:29am
Hi Hopefull and welcome to the forum.

I am presently making some minor revisions to the Down With Acid book prior to having it reprinted. (You may see a preview of the relevant pages about PPI safety here.)

If PPIs (eg pantoprazole) are prescribed, there is the onus on the doctors to ensure their use is reviewed periodically, with blood tests if required. But most of us with Barrett's, their use is recommended for life as they have been found to reduce the risk of progression towards cancer.

Those purchasing PPIs Over The Counter (eg Nexium in UK but most are available OTC in US) are warned in the Patient Information Leaflet they should only be used for a few weeks. That is because they may be used inappropriately.

This paper, The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice provides a list of 10 advice pointers from American Gastroenterological Association, the first 4 of which are:

Best Practice Advice 1: Patients with GERD and acid-related complications should take a PPI for short-term healing.

Best Practice Advice 2: Patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to stop or reduce them.

Best Practice Advice 3: Patients with Barrett’s esophagus and symptomatic GERD should take a long-term PPI.

Best Practice Advice 4: Asymptomatic patients with Barrett’s esophagus should consider a long-term PPI.

80mg Pantoprazole is a "normal" high dose equivalent to 40mg omeprazole or 60mg lansoprazole. Many patients need that dose but, it may be reduced to half that on review.
I have used PPIs for more than 20 years and was actually on very high dose, 80mg omeprazole, for a few years prior to a fundoplication. I now take a 20mg maintenance dose.
That high a dose for a long time made me anaemic due to induced hypochlorhydria which required some iron supplementation.

All the best
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